Fusion Registration Form 2018
Registration for Fusion Youth group at MEC
Young Person’s Details
Child’s First Name *
Your answer
Child’s Last Name *
Your answer
Address *
Your answer
D.O.B *
MM
/
DD
/
YYYY
Gender *
Parent’s Email *
Your answer
Child’s Email
Your answer
Home Number
Your answer
Parent’s Mobile *
Your answer
Child’s Mobile (used for information sharing only)
Your answer
Best way to contact young person? *
Required
Current School Year (or equivalent) *
School name *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Does your young person have any allergies/medical conditions? *
Details of allergies/medical conditions
If yes above, please give details.
Your answer
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